Employee Benefits Health Insurance
Resume:
Twila N. L. Cawthon
Tallahassee, Florida *****
850-***-**** - ************@*****.***
Work History
Senior Problem Resolution Specialist
Alight – Tallahassee, Florida
Manage the administration of employee benefits programs, including health insurance, retirement plans, wellness initiatives, and other voluntary benefits.
Manage a team of 12—15 staff to ensure that 98% of escalated claims are processed in a timely manner and route accordingly to Alight policy and procedures.
Coordinate with benefits vendors, brokers, and third-party administrators to ensure accurate and timely delivery of benefits services and support.
Monitor benefits trends, regulations, and market practices to assess the competitiveness and effectiveness of current benefits offerings and recommend enhancements or changes as needed.
Conduct analysis and benchmarking of benefits plans to evaluate plan performance, cost-effectiveness, and alignment with organizational objectives.
Collaborate with HR leadership and finance teams to develop and implement strategic changes to benefits plans, including plan design modifications, cost-sharing arrangements, and vendor negotiations.
Utilize data analytics and modeling techniques to forecast and evaluate the financial impact of proposed benefits changes and provide recommendations to senior management.
Ensure compliance with all relevant federal, state, and local regulations governing employee benefits, including ERISA, ACA, HIPAA, and COBRA.
Monitor legislative and regulatory developments affecting employee benefits and proactively assess their impact on benefits programs, communicating updates and recommendations to HR leadership and other stakeholders.
Oversee the preparation and distribution of required benefits communications, notices, and disclosures to employees, ensuring accuracy and timeliness.
Develop and implement communication strategies to educate employees about benefits offerings, enrollment procedures, and available resources.
Coordinate benefits orientation sessions, workshops, and other educational events to help employees understand their benefits options and make informed decisions.
Serve as a primary point of contact for employee inquiries related to benefits, providing timely and accurate information, and resolving issues as needed.
Cultivate and maintain effective relationships with benefits vendors, brokers, consultants, and other external partners to ensure high-quality service delivery and support.
Evaluate vendor performance and service levels on an ongoing basis, identifying opportunities for improvement and addressing concerns or issues as they arise.
Negotiate contracts, service agreements, and pricing terms with benefits vendors to achieve favorable outcomes for the organization while balancing cost considerations and service quality.
01/2007 to 08/2019
Carrier Specialist/Caseworker and Appeals Representative
Northgate Arinso – Tallahassee, Florida
Receive and review appeals filed by employees regarding disciplinary actions, terminations, grievances, or other employment-related issues.
Gather relevant documentation, including employee statements, HR records, and company policies, to assess the validity of each appeal.
Maintain accurate records of appeals, investigations, and resolutions, ensuring confidentiality and compliance with data protection regulations.
Conduct thorough investigations into employee appeals, gathering information from all relevant parties and documenting findings.
Collaborate with HR partners, legal advisors, and other stakeholders as needed to ensure a fair and impartial review process.
Facilitate mediation sessions or meetings between employees and management to address concerns, clarify misunderstandings, and explore potential resolutions.
Provide guidance and support to both parties throughout the appeals process, helping to negotiate fair and mutually acceptable outcomes when possible.
Make recommendations for resolution based on investigation findings, company policies, and legal considerations, ensuring consistency and fairness in decision-making.
Communicate effectively with employees, managers, and HR team members to keep all parties informed of the appeals process status and any relevant updates.
Prepare written summaries of investigations, findings, and recommended actions for review by HR leadership or other decision-makers.
Document all interactions, decisions, and outcomes related to appeals, maintaining comprehensive and organized records for future reference.
Stay updated on employment laws, regulations, and industry best practices related to employee appeals and dispute resolution.
Ensure compliance with company policies, procedures, and legal requirements throughout the appeals process.
Collaborate with HR leadership to review and update HR policies process and procedures
Processed agency error request corrections per Florida Statues (Chapter 110.123), Florida Administrative Code (60-P) guidelines.
to improve transparency, fairness, and efficiency in handling appeals
08/2003 to 12/2006
Customer Service Representative /Reinstatement Specialist
Converges – Tallahassee, Florida
Serve as the primary point of contact for employees seeking reinstatement.
Coordinate reinstatement processes, including reviewing documentation, scheduling meetings, and facilitating communication between employees and relevant departments.
Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
Ensure compliance with company policies, procedures, and legal requirements regarding reinstatement.
Maintain accurate and up-to-date records of reinstatement activities, including documentation of meetings, agreements, and any relevant correspondence.
Provide guidance and support to employees throughout the reinstatement process, addressing their questions, concerns, and needs.
Collaborate with HR partners to assist employees with accessing resources such as benefits, training, and accommodations as needed.
Communicate effectively with employees, managers, and HR team members to keep all parties informed of the reinstatement process status and any relevant updates.
Facilitate communication between employees and managers to ensure clarity regarding expectations and responsibilities upon reinstatement.
Address any conflicts or issues that may arise during the reinstatement process, working to find mutually beneficial solutions and ensure a positive reintegration experience for all parties involved.
Develop and deliver training programs or materials related to the reinstatement process for employees, managers, and HR staff.
Stay updated on best practices, legal requirements, and industry trends related to employee reinstatement and provide recommendations for process improvements.
02/2001 to 04/2003
Bank Teller
Capital City Bank – Tallahassee, Florida
Process customer transactions, including deposits, withdrawals, loan payments, and account transfers.
Verify customer identity and ensure compliance with regulatory requirements for financial transactions.
Count and balance cash drawers at the beginning and end of each shift to ensure accurate cash handling.
Provide information to customers about bank products and services, including account features, loan options, and interest rates.
Respond to customer inquiries and resolve issues or concerns promptly and professionally.
Assist with account openings, including collecting necessary documentation and inputting customer information into the bank's systems.
Maintain a clean and organized work area, including the teller station and surrounding areas.
Adhere to bank policies and procedures regarding security, confidentiality, and compliance with banking regulations.
Collaborate with other bank employees to achieve branch goals and objectives.
Stay updated on changes in banking regulations, policies, and procedures to ensure compliance and provide accurate information to customers.
Education
05/1991
High School Diploma
James Rickards High School - Tallahassee, FL
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